Provider Demographics
NPI:1922877638
Name:SANDY SHORES BEHAVIORAL HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:SANDY SHORES BEHAVIORAL HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSER-DEMARTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-513-8627
Mailing Address - Street 1:111 AUTUMN TRL
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9070
Mailing Address - Country:US
Mailing Address - Phone:312-513-8627
Mailing Address - Fax:
Practice Address - Street 1:220 W WASHINGTON ST STE 130
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4359
Practice Address - Country:US
Practice Address - Phone:906-266-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty